Merchant Application Form Please complete the questionnaire below to your best ability and we will be in touch within 24 hours to discuss the next steps. Please enable JavaScript in your browser to complete this form. - Step 1 of 7First, please provide us some contact information about the person applying. We'll use these details to get in contact with you if we have any questions.Name *FirstLastEmail *EmailConfirm EmailPhone *International format including country code and area code. For example, for USA and Canada, please enter +1 888 888 8888.NextPlease provide some details about the company.If you are unsure on any detail, please feel free to skip any non-required field. We can follow up with you to discuss after the application is processed.Company Name *Company Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryCompany Identification NumberMay be the Incorporation Number, VAT ID, EIN, ABN, etc.Company IndustryThe main industry that the company operates in.Company DescriptionPlease provide a brief description about your company, boardly what products are sold, how long you have been operating, number of staff members, and target markets.PreviousNextAdditional Contact Form *Not RequiredAdd Additional ContactsIf you would like to provide additional contact information for key personnel on your staff, such as Technical, Accounting, or Support, please indicate in the above. You'll be able to change this after the application and once your account is set up.Technical Contact NameFirstLastTechnical Contact EmailEmailConfirm EmailAccount Contact NameFirstLastAccount Contact EmailEmailConfirm EmailSupport Contact NameFirstLastSupport Contact EmailEmailConfirm EmailPreviousNextYour company's processing details and historySales Website / URL *The main website where your product/services are sold.Current Approval RatePercentage (or ratio) of transactions which are approved. Example: 80% or 0.80.Average Ticket AmountAverage amount per order (or ticket) in dollars.Average Monthly VolumeTotal volume of approved payments processed per month, on average. Example: $40,000.Accepted Payment TypesVisaMastercardAmerican ExpressDiscoverJCBPaypalOtherOther Payment Types AcceptedIf 'Other' was selected above, let us know what other payment types you accept.Ratio of Accepted Payment TypesExample: 55% Visa, 25% Mastercard, 20% AMEXPreviousNextAcquirer and Payment Service Provider InformationPayment Service Provider *Who currently provides your payment facility: might be Shopify Payments, Stripe, Direct Bank MID (e.g. Chase Bank).Payment GatewayAre you using a Payment Gateway such as NMI, Authorize.Net.LocationLocation of your Payment Processor, Terminal or MID. Acqurier BINMerchant ID (MID) or Card Acceptor ID (CAID)PreviousNextPayShield Service SelectionPlease let us know what PayShield products and services you are interested in.PayShield Services *Chargeback Alerts (Verifi and Ethoca)Express Resolve API and ServiceChargeback Protection GuaranteeChargeback Management ServiceTransaction Recognition (TX Find)PayShield Communicate and TrackOCT Refunding Service3D SecureFraud ScoringCurrent Service Provider *YesNoAre you currently using any of the above services from another company?Current Service ProvidersIf you are receiving the above services from a company already and looking to move to PayShield, please let us know the company and the service.PreviousNextThis is everything we need for now. Please click the submit button below to submit the application. Submit